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Heart Failure Symptoms

Usually the left side of the heart is affected first, and this invariably leads to failure in the right side, the portion of the circulation that delivers blood through the lung system.


This is an early and cardinal sign. A cough is common, and frequently the material brought up is tinged with blood. This is termed hemoptysis. This is the typical set of symptoms.

Breathlessness is referred to clinically as dyspnoea. All levels are experienced. In the initial stages of failure, “effort dyspnoea” is the earliest indication, coming on only with severe exertion. However, as cardiac efficiency decreases, so dyspnoea increases. The threshold of effort needed to bring on breathlessness gradually lowers, so a gradual lessening of physical activity will produce symptoms.

Progressively, it becomes noticeable mainly toward evening, and the simple effort of undressing may produce it. Sleep at night often brings relief, and in the morning a good start may be made to another day. With advancing disease, breathlessness even at rest may take place, and simple efforts involved in speaking, gesturing or making any movement may precipitate dyspnoea. The respiratory movements are shallow, quick and obviously troublesome, and accompanied by much effort. They are never sighing or deep, and are not relieved if the attention is suddenly diverted to something else.

With the progression of time, the patient develops a condition called orthopnoea. This means that breathing difficulty occurs at night during sleep. When the patient is in the recumbent position, a build-up of fluid occurs in the lungs. This reduces the ability to secure adequate oxygenation of the blood.

This may cause the sufferer to awaken with dyspnoea. Often he or she will find it better to sleep propped up with pillows, or even to remain propped up in an easy chair instead of lying flat.

This nocturnal difficulty may suddenly get out of hand, and a condition called paroxysmal cardiac dyspnoea (also commonly called cardiac asthma) may follow. This is an extension of orthopnoea, and it is frequently a striking feature late in heart failure.
The symptoms may be of any degree of severity. Most attacks occur at night, and lying in the recumbent position appears to be the immediate aggravating factor. The inadequacy of the heart as a pump allows a build-up of fluid in the lungs, aggravated by the gravitational flow of blood to the lungs in this position.

This is more common after a hard day’s work and a large evening meal. The patient will suddenly awaken about 2 am with a sense of suffocation and dyspnoea. Gripped with an intense desire to get out of bed, he or she invariably does this at once, and going to the window, throws it open, endeavoring to inhale deeply in an effort to get adequate oxygen into the lungs. There is a sense of constriction in the chest; coughing is common, and often blood-stained fluid is brought up. Breathing may become extremely difficult, and a wheeze, very much like the wheeze of the asthmatic, occurs. The patient is anxious, tense and drawn, and often fears for his or her life. The skin may be pale and cold. Often, the standing position in itself assists in mechanically bringing relief.

A disorder named pulmonary edema is a more severe form of this condition. Often there is pain over the chest, breathing is noisy, and there is coughing and the production of much blood-stained, watery fluid. Sometimes a bluish tinge occurs as inadequate oxygen enters the circulation. Mental confusion can frequently follow from inadequate oxygenation of the higher centers in the brain. This constitutes a medical emergency, and prompt treatment is essential. In advanced cases, a typical breathing pattern develops, referred to as Cheyne-Stokes respiration. Each breath commences as a very shallow inspiration. These gradually increase in depth and speed, until they are forceful and deep. The blood becomes oversupplied with oxygen, and there is then a temporary lull, or gradual reduction in the inspiratory movements. Advanced cases are often associated with irregularities of the heartbeat, and abnormal sounds in the chest and heart.


This is the accumulation of fluid in dependent parts, a common occurrence in heart failure, and indicates that the right side of the heart is reducing in efficiency.

This was once commonly referred to as dropsy, and is a typical symptom of a failing heart. Swelling takes place in dependent parts of the body, the ankles being the most common. But it may occur low down in the back, in the so-called sacral area, about the genital region and in the upper thigh areas.

This is merely another indication that the heart is not pumping all the blood that is being delivered to it and blood is building up on the venous side.

If a person is standing all day, the fluid tends to accumulate about the ankles. Toward the end of the day (or at any time of day in more advanced cases), the ankle disappears altogether. If a finger is pushed into the tissue and then removed, an indentation occurs that may take several minutes to smooth out. It is a bit like poking a finger into a piece of putty. The tissue underneath is saturated with fluid, and indentations from outside pressures remain. Wearing tight shoes or socks will also leave their pattern indented on the swollen part.

Usually, with rest at night, and the feet elevated, the edema tends to vanish by morning, but gradually develops as the day progresses.

Often the degree of edema is a good indication as to the effectiveness of therapy, and lets the doctor know if the treatment is working. Fluid tends to be removed, and the heart often improves in Palpitation (premature beat). Incomplete heart block Typical electrocardiogram (ECG) tracings, made by an electrocardiograph and used in diagnosing irregularities of heart action efficiency with the administration of certain drugs.

Sometimes other internal organs are similarly filled with fluid. The circulation to the intestinal region and liver may be involved. For this reason, the liver may be swollen, and the vessels of the bowel tense and engorged. Appetite may be depressed due to this.

In more advanced stages, fluid tends to seep out into the general abdominal space, accumulating by gravity in the lower regions. This is known as ascites, and is usually a serious indication of advanced cardiac disease.

Other Heart Failure Symptoms

Many other symptoms may be present. Fatigue and exhaustion may occur. Sometimes, a bluish tinge of the lips and extremities and other skin surfaces may indicate inadequate oxygenation of the general blood supply. This will be aggravated if anemia is also present.

The doctor will frequently order various tests that give an indication of the severity of the disease. X-rays will often show enlargement of the chambers of the heart, as they distend and become less efficient. The lungs may show marked congestion, as excessive amounts of fluid accumulate there. The electrocardiogram will also indicate that the heart is not operating efficiently.

Heart Failure Treatment

There are wide variations in the clinical picture of heart failure. It commences as a disorder without symptoms, and gradually (or rapidly) develops into a more serious condition.

The sooner any underlying cause can be found and corrected, the better are the chances of stemming the deterioration. Often other concurrent disorders are present, and can be diagnosed and corrected.

These may include diseases of the heart valves, thyroid disease (thyrotoxicosis, a potent troublemaker), beriberi (often from excessive alcoholic intake) or anemia. However, once established, general principles of treatment follow. These are basically aimed at resting the disordered heart muscle. Physical and mental rest can only assist in allowing the heart to carry out its actions as efficiently as possible without undue outside interference of an artificial kind.

Next, the efficiency of the heart must be improved as much as possible and the tendency to accumulate fluid and salts must be actively treated by the use of fluid-removing tablets, commonly the oral diuretics, now in wide use.


This is important. The amount required will depend on the extent to which the disorder has advanced. If bouts of cardiac asthma are recurring, then with each attack bed rest may be required for a few days.

Physical and mental rest alleviates anxiety and worry; physical repose reduces the amount of work the heart muscle must perform each day. Treatment of the cardiac patient is under the care of a physician.

There is always a fear that doctors keep well in mind. With prolonged rest in bed, and lack of movement, there is an increased risk of clots forming. The calf muscles are a favorite site for this condition, referred to as deep venous thrombosis. Apart from causing marked swelling of the affected limb, a piece of clot may break off and block a major segment of the lung, and this is a serious but ever-present possibility. Often a compromise is made between bed rest and partial ambulation or sitting on a chair.


This is given consideration. With rest, there is less need for large meals, and a 4200 kJ (1000 calories) a day food intake is adequate in the initial stages of therapy. Often the patient does not feel hungry, so that a reduction in food intake is seldom a hardship. Meals must be small but attractively served, for there is always a psychological overlay and the patient needs a certain amount of nutrition. Smaller meals mean that the heart works less in coping with this.

Attention is given to the salt content of food, and a low-salt regimen is sometimes recommended. It is suggested food be served without the addition of salt. Often salt-free food is unpalatable. In the past, many diets have been advocated with severely restricted salt routines. Today, with the extreme efficiency of the fluid-eliminating medication (the oral diuretics), not so much attention is being paid to the need for salt restriction.

There is no need to restrict fluid intake. Some doctors (but not all) believe that there is little reason to eliminate alcoholic beverages from the routine purely for reasons of cardiac health. But on moral grounds, and on the grounds of general health, abstinence may well be justified.


Tobacco use in all forms must be restricted or preferably entirely stopped. The adverse effects of the drugs contained in tobacco smoke and their serious effect on the heart and blood-vessel system arc too well documented for smoking to be permitted. It is best to explain this in a kindly way to the patient, who may suffer adversely in the early stages from such deprivation.

First Aid in Drowning

Treatment prolonged lack of oxygen from being submerged under water leads to cardiac arrest, so it is important that rescue breathing or CPR (either mouth-to-mouth or mouth-to-nose ventilation) be started immediately – even in the water if necessary.

  • Call 911 for medical assistance and a quick transfer to the nearest emergency center.
  • If you know what happened prior to the accident, tell the rescue workers, particularly if head and neck injuries are likely (as would be the case if the child was diving when the accident occurred). Keep the child warm, especially if he was in cold water. Wrap him in towels or a blanket until medical personnel arrive.

Drowning Prevention

Studies show that 70 percent of drowning accidents could be avoided if self-closing, self-latching doors were installed in homes and on gates in the fences around pools. Sturdy, childproof pool covers and alarms on doors leading to the pool area – or even an alarm that sounds when someone enters the water – are also appropriate safety measures. Parents need to teach their children the importance of swimming only when supervised and the necessity of life jackets when boating. Older children and adolescents should be warned explicitly of the risks of alcohol and/or drug consumption while swimming.

When young children are around water, they must always be supervised by an adult. Parents and teens should strongly consider becoming certified in CPR. Poolside telephones are helpful because they allow adults to answer the phone while continuing supervision. They also can speed the process of calling for help if an accident occurs.

Chances of Surviving Drowning

The chances of surviving submersion are not significantly affected by the type of water (salt, fresh, or pool water with chemicals). How long a child can survive without oxygen depends on many other factors, including age, previous health, the water temperature, and the speed and effectiveness of the rescue effort. Children under age five have an advantage because of a nerve reflex that causes the heart to slow down and blood to be directed to the brain and heart. Younger children usually survive if submersion lasts less than 3 minutes and may survive a submersion lasting up to 10 minutes if the water temperature is 50° to 60°F (10° to 15°C). In general, cold water temperatures improve survival chances.

ADHD Symptoms

Inattention and Distractability

An ADHD child cannot stay focused on any task that requires continuous attention, especially schoolwork. He may daydream or become distracted by any sight or sound in his vicinity. Completing an assignment can require much effort, but he is likely to misplace the final product between home and school. He cannot remember a sequence of directions: “Take out the trash, feed the bird, and pick up your clothes before you take your bath” might result in one or at most two of the commands being completed. The others will be forgotten or jumbled.


Perpetual motion has traditionally been the most striking trademark of ADHD, but in fact it is prominent in only about 30 percent of children who have the disorder. Experts now divide children with ADHD into subtypes based on their most overt characteristic: lack of attention, hyperactivity, or a blend of the two. While difficulty with attention may not be apparent until the child enters school, hyperactivity makes an impact on everyone in his world from the time he is young.

Some parents are aware that “something is different,” from the first days of life with their demanding baby who later turns into a turbocharged toddler. Most parents of small children wish they could acquire some of the energy of their offspring, but the hyperactive child is in a different league, living every day at top speed. Many children with ADHD also have volatile modal. Whether they are joyful or angry, everyone in earshot will hear about it. Just as rapidly, these feelings seem to pass as the child forgets the episode and moves on to some-else.


The child with ADHD has a little timer. He cannot wait his turn, stand in line, follow directions, or keep his hands off whatever he supposed to touch. He talks before he thinks, acts before he analyzes, and leaps before he looks. As a result, he suffers more than a few battle wounds and fractures.

ADHD has been given many names over the US including Minimal Brain Dysfunction and Hyperkinetic Reaction of Childhood. The following causes have been related to ADHD: brain damage, birth trauma, poor parenting, lack of discipline, food additives, sugar and pure wilfulness. The best understanding at present is that the primary basis for ADHD is neurochemically subtle inherited malfunction of the intricate passing messages between cells in the brain. So far, no spool medical finding, blood test, or X-ray is sensitive CTIOU to detect the abnormality, although a doctor’s evaluation is important in ruling out other causes of the troublesome behavior.

The child with ADHD exhibits difficulties in many areas of life (home, school, playground), but not a beam to the same degree, and parents may be confused or frustrated by some of the inconsistencies. Certain activities – usually ones that are highly intense such as games – can hold his interest, at times to a striking degree. In some one-on-one situations, he may act quite normal. This variability is actually very typical with ADHD, but it gives the definite impression that the child’s lack of attention is simple laziness or that impulsivity is wilful defiance.

One of the greatest challenges of parenting an ADHD child is discerning how much of a particular behaviour arises from biology and how much from consciousness. As the child grows older, the causes may blend. For example, extreme difficulty with schoolwork, which requires prolonged concentration and mental effort, them to dislike and then eventually to refusal to participate.

Repeated rejection by others because of behavior hest control may push him toward more deliberately excessive acts.

Global Warming Facts

  • Global warming is the increase in average temperatures around the world. This increase has been between 0.3°C and 0.8°C over the 20th century.
  • Most scientists now think that global warming is caused by human activities, which have resulted in an increase in the Earth’s natural greenhouse effect.
  • The greenhouse effect is the way that certain gases in the air – notably carbon dioxide – trap some of the Sun’s warmth, like the panes of glass in the walls and roof of a greenhouse.
  • The greenhouse effect keeps the Earth pleasantly warm – but if it increases, the Earth may become very hot.
  • Many experts expect a 4°C rise in average temperatures over the next 100 years.
  • Humans boost the greenhouse effect by burning fossil fuels, such as coal, oil and natural gas that produce carbon dioxide.
  • Emission of the greenhouse gas methane from the world’s cattle has added to the increase in global warming.
  • Global warming is bringing stormier weather by trapping more energy inside the atmosphere.
  • Global warming may melt much of the polar ice caps, flooding low-lying countries such as Bangladesh.
  • Recent observations show global warming 14 could be much worse than we thought.

Kiwi Facts

  • There are three species of kiwi, found only in New Zealand. All are flightless birds that live in burrows. The female dwarf cassowary, or moruk, is an extremely dangerous bird and will attack anything that comes near its nest with its 10-cm long claws. The three species of cassowary live in rainforests in New Zealand and northeastern Australia. Largest of its family is the brown kiwi, which is about 55 cm long and weighs up to 3.5 kg.
  • Only the kiwi has nostrils at the end of its beak.
  • The kiwi is the national symbol of New Zealand, appearing on stamps, coins and banknotes.
  • Cassowaries in Australia are known to eat the fruits of at least 75 different types of tree.
  • The female cassowary mates with several males, laying 6-8 eggs each time. The males care for the young.
  • About 1200 years ago there were probably 12 million kiwis in New Zealand. Today there are only 70,000.
  • The nocturnal kiwi’s good sense of smell helps it to find worms, insects and spiders in the ground at night.
  • A kiwi lays the largest eggs for its size of any bird – each egg weighs 25% of its body weight. Females lay up to 100 in a lifetime.

Facts About Air Pressure

  • Although air is light, there is so much of it that air can exert huge pressure at ground level. Air pressure is the constant bombardment of billions of air molecules as they zoom about.
  • Air pushes in all directions at ground level with a force of over 1 kg per sq cm – that is the equivalent of an elephant standing on a coffee table.
  • Air pressure varies constantly from place to place and from time to time as the Sun’s heat varies.
  • Air pressure is measured with a device called a barometer in millibars.
  • Normal air pressure at sea level is 1013 mb, but it can vary from between 800 mb and 1050 mb.
  • Barometers are used to detect changes in air pressure. The first barometer was invented by Evangelista Toricelli in 1644.
  • In this satellite picture, a spiral of clouds indicates that stormy weather in a depression is heading for California, USA.
  • Air pressure is shown on weather maps with lines called isobars, which join together places of equal pressure.
  • High-pressure zones are called anticyclones; low-pressure zones are called cyclones, or depressions.
  • Barometers help us to forecast weather because changes in air pressure are linked to changes in weather.
  • A fall in air pressure warns that stormy weather is on its way, because depressions are linked to storms.
  • Steady high pressure indicates clear weather, because sinking air in a high means that clouds cannot form.

Saturn Facts

  • Saturn is the second biggest planet in the Solar System – 815 times as big in volume as the Earth, and measuring 120,000 km around its equator.
  • Saturn takes 29 and a half years to travel round the Sun, so Saturn’s year is 29.46 Earth years. The planet’s complete orbit is a journey of more than 4.5 billion km.
  • Winds ten times stronger than a hurricane on Earth swirl around Saturn’s equator, reaching up to 1,100 km/h – and they never let up, even for a moment.
  • Saturn is named after Saturnus, the Ancient Roman god of seed-time and harvest. He was celebrated in the Roman’s wild, Christmas-time festival of Saturnalia.
  • Saturn is not solid, but is made almost entirely of gas – mostly liquid hydrogen and helium. Only in the planet’s very small core is there any solid rock.
  • Because Saturn is so massive, the pressure at its heart is enough to turn hydrogen solid. That is why there is a layer of metallic hydrogen around the planet’s inner core of rock.
  • Saturn is one of the fastest spinning of all the planets. Despite its size, it rotates in just 11.5 hours – which means it turns round at over 10,000 km/h.
  • Saturn’s surface appears to be almost completely smooth, though Voyager 1 and 2 did photograph a few small, swirling storms when they flew past.
  • Saturn has a very powerful magnetic field (see magnetism) and sends out strong radio signals. Saturn’s rings are made of many millions of tiny, ice-coated rock fragments Saturn is almost as big as Jupiter.
  • Saturn’s rings are sets of thin rings of ice, dust and tiny rocks, which orbit the planet around its equator.
  • The rings shimmer as their ice is caught by sunlight.
  • The rings may be fragments of a moon that was torn apart by Saturn’s gravity before it formed properly.
  • Galileo was first to see Saturn’s rings, in 1610. But it was Dutch scientist Christian Huygens (1629-95) who first realized they were rings, in 1659.
  • There are two main sets of rings – the A and the B rings.
  • The A and B rings are separated by a gap called the Cassini division, after Italian astronomer Jean Cassini (1625-1712), who spotted it in 1675.
  • A third large ring called the C or crepe ring was spotted closer to the planet in 1850.
  • In the 1980s, space probes revealed many other rings and 10,000 or more ringlets, some just 10 m wide.
  • The rings are (in order out from the planet) D, C, B, Cassini division, A, F, G and E. The A ring has its own gap called the Encke division.

Animal Migration Facts

  • Migration is when animals move from one place to another to avoid the cold or to find food and water.
  • Some migrations are daily, some are seasonal, and some are permanent.
  • Starlings migrate every day from the country to their roosts in towns and cities.
  • Many birds, whales seals and bats migrate closer to the tropics in the autumn to escape the winter cold.
  • One knot (a kind of small bird) took just 8 days to fly 5,600 km, from Britain to West Africa.
  • Barheaded geese migrate right over the top of the Himalayan mountains, flying as high as 8,000 m.
  • Migrating birds are often brilliant navigators. Bristle-thighed curlews find their way from Alaska to tiny islands in the Pacific 9,000 km away.
  • Shearwaters, sparrows and homing pigeons are able to fly home when released by scientists in strange places, thousands of kilometres away.
  • The Arctic tern is the greatest migrator, flying 30,000 km from the Arctic to the Antarctic and back again each year.
  • Monarch butterflies migrate 4,000 km every year, from North America to small clumps of trees in Mexico. Remarkably, the migrating butterflies have never made the journey before.
  • No other creature migrates so far every year as the Arctic tern. It breeds in the short Arctic summer, then flies halfway around the world to spend another summer in Antarctica.
  • In summer, moose spend most of the time alone. lin winter they gather and trample areas of snow (called yai to help each other get at the grass bole,
  • Migration is the journey made twice a year between a summer breeding area, where food is plentiful, and a wintering area with a good climate.
  • Many migrating birds have to build up fat stores to allow them to fly non-stop for many days without food.
  • A migrating bird can fly across the Sahara Desert in 50-60 hours without stopping to ‘refuel’.
  • Birds find their way by observing landmarks, the patterns of stars and the position of the setting sun. They also use their sense of smell and monitor the Earth’s magnetic field.
  • Most birds that migrate long distances fly at night.
  • The snow goose migrates nearly 5000 km south from Arctic Canada at an altitude of 9000 m.
  • Before migration was studied, some people thought swallows simply spent the winter asleep in mud.
  • Even flightless birds migrate. Emus make journeys on foot of 500 km or more, and penguins migrate in water.
  • Every year at least 5 billion birds migrate from North to Central and South America.
  • The Arctic tern spends the northern summer in the Arctic and migrates to the Antarctic for the southern summer, enjoying 24 hours of daylight in both places.
  • Florida manatees usually migrate south in winter, but recently they have moved instead into the warm water outlets of hydroelectric generating plants.
  • Hooded seals usually migrate south from Greenland in the Atlantic Ocean, but in 1990 one seal ended up off California in the Pacific, having taken a wrong turn.
  • Migrating noctule bats established themselves in Hawaii, after being blown 3000 km off course.
  • Migrating whales travel immense distances with the aid of their internal magnetic navigation.
  • Oil pipe-lines are serious obstacles to caribou, which follow traditional migratory routes every year.
  • Migrating European noctule bats fly at high altitude, emitting loud, low frequency sounds at one second intervals to keep in ground contact.
  • American grey squirrels sometimes travel in their thousands, crossing roads, rivers and towns in their search for food.
  • Beluga whales return to the estuaries where they were born to give birth.
  • Over 1 million wildebeest take part in a circular seasonal migration in east Africa’s Serengeti region. Each year, grey whales migrate 20,000 km in all, going to and from their breeding grounds.

Deer Facts

  • Antelopes and deer are four-legged, hooved animals. Along with cows, hippos and pigs, they belong to the huge group called artiodactyls – animals with an even number of toes on each foot.
  • Antelopes and deer chew the cud like cows – they chew food again, after first partially digesting it in a special stomach.
  • Most antelope species live in herds in Africa. Many are very graceful, including the impala and Thompson’s gazelle. Most are also fast runners.
  • The horns on an antelope’s head last its lifetime.
  • Deer have branching antlers of bone (not horn) on their heads, which drop off and grow back again each year.
  • Most deer species live in woods and grasslands in mild regions such as northern Europe and North America.
  • The moose or elk grows antlers that are more than 2 m wide.
  • Male deer are called stags, young males are bucks, females are does and babies are fawns.
  • Usually only stags have antlers. The only female deer to have them are caribou or reindeer, which are the same species of deer but with different names.
  • Caribou can survive in the icy cold of Spitsbergen Island in the Arctic circle.


As there are so many organs involved, it is likely that malfunctions will take place from time to time. In the main, these happen surprisingly seldom. But as with any bodily organ, with the passage of time, and with wear and tear, with the incessant bombardment of hostile outside influences such as viruses and bacteria, a series of pathological disorders may take place.

Infections can occur. Overgrowth of tissue may occur. Cancers can grow, as certain cells take on abnormal qualities and develop along these bizarre lines causing neoplasms or new growths or carcinomas—all words meaning cancer. This section sets out the chief abnormalities that can occur in the urinary system. Some are very common and affect many people. Others are rare and are seldom seen in everyday life.

More attention has been focused on the common disorders and those that the reader might contract or develop or hear about. It is not meant to be a total encyclopedia of urinary-tract knowledge, but a discussion of practical value that may be of some everyday use.

The key parts, we believe, are the sections dealing with symptoms, for these are the factors of vital importance. These are the telltale features that may occur. If one has some knowledge of them, knows what to look for, knows what the hidden meaning may be, then there will be much more incentive to act. Action in medicine is often imperative to prevent the development of what starts out to be something simple, into something that may be disastrous.

On a regular, ongoing basis, more information and knowledge are being amassed each year.

The kidney structure in itself has an incredible number of classifications and sub-classifications and lists of names that are too much for even some doctors, to say nothing of the confusion that exists with the lay reader.

An effort to be as up to date as possible has been made with all parts of this book. Some of the more recent work is of academic interest mainly, and often makes little difference to the actual handling and treatment of a sick patient. Some areas in this section may be in the melting pot of current research, and may change in certain respects as time passes. But for all practical purposes it should remain “in date” for some time to come.